Clinical Nutrition Open Science (Dec 2021)
High prevalence and burden of adult malnutrition at a tertiary hospital: An opportunity to use nutrition-focused care to improve outcomes
Abstract
Summary: Background & aims: Disease-associated undernutrition is common among hospitalized adults around the world, but risk is expected to be even greater in regions of food insecurity, as in Southeast Asia. Our study, which was based in a large Vietnamese hospital, aimed to determine the prevalence of undernutrition and its associated health and economic burdens. Methods: We conducted a retrospective analysis of medical records for a cohort of 1600 adult patients who were admitted to the University Medical Center (UMC) hospital in Ho Chi Minh City, Vietnam over a 2.5-year interval. Undernutrition or its risk was identified as [1] a diagnosis of malnutrition by a physician, and/or [2] a body mass index (BMI) < 18.5, and/or [3] a score ≥ 3 on the Nutritional Risk Screening (NRS)-2002, and/or [4] in-hospital use of oral nutritional supplements, as recorded in the patient's medical chart. Our study also tracked comorbidities and their severity and compiled data on hospital length of stay and infectious complications during the hospital stay or within 30-days post-hospitalization. We determined costs for the full study population, and we also stratified results by admission source. Results: We found that 2 of every 3 hospital study patients were undernourished or at risk for malnutrition, based primarily on BMI < 18.5 kg/m2 or NRS-2002 score ≥ 3. The highest prevalence of malnutrition risk occurred in patients undergoing gastrointestinal surgery (84.8%), and the lowest among cardiology patients (48.9%). On average, patients were 80.2 years of age, predominantly female (58%), of Kinh ethnicity (95%), with 2.1 comorbid conditions, and public health insurance (84%). Infectious complications occurred in 4% of patients, and hospital length of stay was 8.4 (±4.6) days. Of patients contacted in post-discharge follow-up (N=987), 20.6% had been readmitted to the hospital within 30-days post-discharge. The average total episode cost was 31.6x106 (±28.1x106) VND. Conclusions: Among hospitalized patients in Vietnam, we found that disease-related undernutrition is highly prevalent, which can worsen patient outcomes, increase healthcare resource use, and elevate healthcare costs. To address these problems, we propose use of a nutrition-focused action plan that aims to enhance awareness of nutrition gaps and improve professional training for identification of undernutrition and for delivery of needed nutrition care.
